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Marked variation in newborn resuscitation practice: a national survey in the UK.

ABSTRACT: BACKGROUND:Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. OBJECTIVE:Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. METHODS:We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009-2010 (n=192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. RESULTS:There was an 89% response rate (n=171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P=0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P<0.0001) and fewer in 100% oxygen (11% vs. 41%, P<0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P<0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. CONCLUSIONS:In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications.

SUBMITTER: Mann C

PROVIDER: S-EPMC3350052 | biostudies-literature | 2012 May

REPOSITORIES: biostudies-literature

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Marked variation in newborn resuscitation practice: a national survey in the UK.

Mann Chantelle C Ward Carole C Grubb Mark M Hayes-Gill Barrie B Crowe John J Marlow Neil N Sharkey Don D

Resuscitation 20120112 5

<h4>Background</h4>Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices.<h4>Objective</h4>Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services.<h4>Methods</h4>We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009-2010 (n=192). Differences ...[more]

PMID: 22245743

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Project description:BackgroundPre-hospital emergency anaesthesia is a critical intervention undertaken by helicopter emergency medical teams. Previous studies informed current practice for induction regimes, using a standardized approach of fentanyl, ketamine and rocuronium. There may be a trend towards post-induction hypotension attributed to the induction regime used. Several new combinations of fentanyl, ketamine and rocuronium are emerging in clinical practice. There is currently no consensus on what induction regimes should be used.MethodsA semi-structured survey was distributed to the medical leads of all UK air ambulance organisations between December 2022 and February 2023. Responses that were returned within the study period were included. Exclusions included missing data, declined participation and failure to return the survey within the data collection period. The survey sought to establish provision of pre-hospital emergency anaesthesia and current induction regimes for stable, unstable and post-cardiac arrest patients. Data was extracted from Microsoft Forms into Excel. Descriptive statistics were used to analyse survey response rate, provision of PHEA and induction regimes. The survey was endorsed by the National HEMS Research and Audit Forum.Results19 air ambulance organisations responded (response rate 86%). The majority of organisations provide over 100 pre-hospital emergency anaesthetics per annum (79%, n = 15/19). A standard combination of fentanyl, ketamine and rocuronium is used as a primary induction regime in haemodynamically stable patients by 52% of services (n = 10/19). In haemodynamically compromised patients, fentanyl was omitted or pracititioner choice emphasized by 79% of services (n = 15/19). There was variability in the dose of rocuronium from 1 mg/kg to 2 mg/kg throughout services.ConclusionThere is variability in the approach to pre-hospital emergency anaesthesia. There is a growing dataset that would enable development of a registry to better understand induction regimes and the impact on patient physiology. Organisations are increasingly adopting a patient centered, practitioner choice model towards induction of anaesthesia.

Dataset Information

Marked variation in newborn resuscitation practice: a national survey in the UK.

Publications

Marked variation in newborn resuscitation practice: a national survey in the UK.

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